Personality Disorders

Personality disorders are stable and enduring patterns of thought, feeling, and behavior (i.e., trait-like syndromes) that emerge relative early (by adolescence) that deviate from the norms of one’s culture that are pervasive and inflexible across many aspects of one’s life and that lead to distress or impairment (negative consequences for the functioning and the happiness of the individual) (DSM-IV, 1994)

Brief descriptions of the DSM-IV Personality Disorders Cluster and disorder Description Cluster A (odd, eccentric) Schizoid Extreme detachment and lack of interest in relationships Schizotypal Discomfort in close relationships, combined with eccentric behaviors and thoughts Paranoid Extreme distrust and suspiciousness of others Cluster B (dramatic, emotional, erratic) Antisocial Disregard for and violation of the rights of others Borderline Extreme impulsivity and instability of relationships, self-image, and emotions Histrionic Excessive attention seeking and exaggerated expression of emotions Narcissistic Excessive sense of self-importance and entitlement Cluster C (anxious, fearful) Avoidant Extreme shyness, low self-esteem, and fear of rejection Dependent Excessive need to be taken care of, with submissive and clinging behavior Obsessive-compulsive Excessive preoccupation with order, perfection, and control

Cluster A disorders (odd, eccentric) Schizoid extreme degree of detachment from others very limited expression of emotions not interested in family, sexual, work, or friendship relationships prefers almost always to be alone indifferent to praise or criticism feels little joy or pleasure (anhedonia)

Cluster A disorders (odd, eccentric) Schizotypal detachment from others extreme discomfort with social relationships a pattern of odd thinking and eccentric behaviors superstitious or fascinated with the paranormal bizarre perceptual experiences

Cluster A disorders (odd, eccentric) Paranoid strong suspiciousness of others’ motives sense of being persecuted quick to take offense when none is intended likely to hold grudges

Cluster B disorders (dramatic, emotional, erratic) Antisocial disregards and violates the rights of others lies to and “cons” others for personal gain has no remorse for the harm they cause others aggressive, irresponsible, impulsive, and reckless

Cluster B disorders (dramatic, emotional, erratic) Borderline extreme instability in own self-image and in relationships with others extreme impulsivity in various contexts alcohol abuse, binge eating, spending sprees, sexual escapades self-harming behaviors such as self-mutilation or suicide attempts “love/hate” relationships extreme fear of abandonment extremely moody and temperamental

Cluster B disorders (dramatic, emotional, erratic) Histrionic exaggerated attention seeking and exaggerated display of emotion intense need to be the center of attention use of physical appearance to draw attention has a seductive and sexually provocative style “drama queens” (or “drama kings”) whose emotions are actually shallow and rapidly changing tend to consider casual acquaintances as being much closer than is actually the case

Cluster B disorders (dramatic, emotional, erratic) Narcissistic grandiose sense of self exaggerated sense of innate personal worth and entitlement selfish lack of concern for others’ needs arrogant and exploitative fantasizes having fame, power, wealth, and universal admiration, and envies people who have these things

Cluster C disorders (anxious, fearful) Avoidant extremely shy and socially inhibited plagued by feelings of inadequacy and oversensitivity to possible negative evaluation by others strong fears of criticism, disapproval, or rejection low self-esteem wants social contact but is afraid of rejection

Cluster C disorders (anxious, fearful) Dependent excessive need to be taken care of submissive, clinging behavior fears of separation strong need for advice and reassurance need other people to take responsibility for important features of their lives feel unable to take care of themselves when alone will desperately seek a new “security blanket” relationship if the previous one is lost

Cluster C disorders (anxious, fearful) Obsessive-compulsive extreme preoccupation with orderliness, perfection, and control so obsessed with getting the details right that sometimes the entire point of the activity is lost so perfectionistic and rule-bound that they have difficulty delegating and completing projects on time tend to put perfectionistic goals ahead of personal relationships stubborn, inflexible, and likely to hoard money and objects

Disorders considered for inclusion in the DSM-IV but rejected Description Depressive Chronic unhappiness, low self-esteem, and pessimism Passive-aggressive (negativistic) Excessively negative attitudes and passive resistance to others’ requests Sadistic Cruelty and fascination with violence Self-defeating Undermines own happiness and repeatedly enters harmful situations and relationships

Other personality-related disorders not included in the DSM-IV Description Attention-deficit hyperactivity disorder Extreme inattention, impulsivity, and hyperactivity Separation anxiety Excessive anxiety and fear about separation from one’s attachment figure Oppositional defiant disorder Extreme hostility, defiance, anger, and disobedience Specific phobia Excessive fear of some class of objects or situations (blood, animals, heights, etc.)

Problems with the concept of personality disorders Symptoms of a given disorder do not necessarily “go together.” Two disorders may have overlapping symptoms, and may tend to be diagnosed together (the issue of “comorbidity”). “Clusters” of disorders do not match factor analytic results. A personality disorder should be seen as a continuum, not as a category. Disorders with a clear personality basis are excluded if those disorders are observed in children. Some disorders have their origins in sexist stereotypes.